CANMORE – Frontline health care workers at Canmore General Hospital have been working relentlessly behind the scenes on a response plan for the COVID-19 pandemic, including planning for worst-case scenarios.
The plan has many layers, including extra areas of the hospital that have been identified in the event of a surge in the number of COVID-19 cases, with predictions of a potential peak in mid-May.
Emergency room workers are doing simulations to practise treatments for the sickest of the sick, and a newly established critical care working group is in constant communication with counterparts in Calgary where the closest intensive care unit (ICU) is located.
“The philosophy we’re going by is to be over-prepared and to make sure we’re acting and not reacting to what’s happening,” said Dr. Kyle McLaughlin, an emergency physician at the hospital.
“At the end of the day, we may say maybe some things were not necessary, but that’s OK. From a rural hospital standpoint, I know we’re ahead of the curve in what we’ve been doing.”
Canmore hospital’s emergency department pandemic planning includes a critical care working group – made up of emergency doctors, nurses, anesthetists and EMS – who are dealing with the public health crisis front and centre.
McLaughlin, who is also Parks Canada’s medical director for Banff, Yoho, Kootenay and Kluane national parks as well as the medical consultant for Canadian Mountain Holidays (CMH), has been overseeing much of the work, but he emphasizes this is a team effort.
“This is different from what the hospital has been working on doing their capacity assessments from an administrative side,” said McLaughlin.
“What we’re basically focussing on is our emergency response for the sickest of the sick.”
Part of the pandemic preparation at the Canmore hospital includes creating four new isolation assessment and treatment beds, and converting two more beds into isolation beds.
“In all, we have more than doubled our capacity for isolation assessment and treatment areas,” said McLaughlin.
“We have also dedicated an area on our acute care area of the hospital for admitted suspected COVID positive patients. This area is separated from the non-COVID positive patients.”
Other areas in the hospital have also been identified as potential spaces for COVID-19 patients, such as an operating room as one example.
“If we are in an overwhelmed situation, how would we use these rooms and what are some potentials?” said McLaughlin.
“We can move people to appropriate areas to try to make sure we minimize the potential of other people getting it … but also ensuring that we care for everybody at the highest level.”
A tent set up by Canmore Fire-Rescue near the entrance to the hospital last week could potentially be used for added capacity, if necessary.
“We are very thankful to the fire department for donating that tent,” said McLaughlin. “We’re not using it right now, but it’s another option for us to move into.”
Presently, the hospital is modelling out options for use of areas, including during different phases of the pandemic.
“As our number of patients increases, we have the potential of using that tent for a number of different things – everything from a waiting room to a triage area to potentially a treatment area,” said McLaughlin.
“If they adapt and change our testing policies it could be an isolated testing area. It gives us a whole lot of flexibility. We’re in the midst of discussing that and drawing out different options and trying to figure out what the triggers would be to use that extra space.”
So far in the Canmore region, which also includes MD of Bighorn hamlets, there are 15 confirmed COVID-19 cases. Five cases remain active, while 10 people have recovered.
In neighbouring Banff and Lake Louise, there are three active novel coronavirus cases.
As of Tuesday (April 14), the total number of COVID-19 cases in Alberta is 1,870. The total deaths in the province are 48, but there are now 914 confirmed recovered cases.
Of these cases, there are currently 44 people in hospital, including 14 patients admitted to intensive care units (ICU).
In addition to testing in hard-hit areas and testing of vulnerable people and essential workers, AHS has expanded testing to anyone showing symptoms of COVID-19 including cough, fever, runny nose, sore throat or shortness of breath, is now eligible for testing.
Dr. Deena Hinshaw, Alberta’s chief medical officer of health, who announced the additional testing on Monday (April 13), said this aims to help better trace the spread of the novel coronavirus.
“We have seen from other jurisdictions that have successfully flattened the curve that aggressive testing is essential to controlling the spread,” said Hinshaw.
“Going forward, testing all symptomatic Albertans will give us a more complete picture of trending over time.”
As of last Friday, McLaughlin said Canmore didn't have any patients admitted to the hospital with COVID-19, and to the best of his knowledge, no-one had been transferred to Calgary ICU that had tested positive.
“We’re anticipating numbers are going to go up, but the really important factor to me is the hospitalizations and intensive care numbers,” he said.
“The community and people who do come and see us in emergency are very cognizant of what’s going on. We have a very health-conscious and educated community here, so I think that everyone is just doing an excellent job of doing their part.”
In the early stages of preparation, the emergency department began doing simulations – an exercise that recreates real world processes in a controlled environment, in this case for COVID-19.
“Simulations, in general, are a highly effective tool for us to recreate medical scenarios that we will we see,” said McLaughlin, noting the hospital has had a simulation program for many years.
For this pandemic, a team of nurses and emergency physicians practice various complex scenarios that could happen with COVID-19 patients. The simulations include important pre-briefings and debriefings.
“It’s a very realistic scenario. We recreate a trauma room and have a mannequin that we can do a number of different things. We can put a breathing tube into it, we can put IV fluids, we use all the same equipment,” McLaughlin said.
“The goal is to understand the complexities of these critical care patients, to understand what are the best treatment measures that we can do for these patients. We are working very hard to be prepared.”
Another vital aspect of the simulation work is to make sure health-care workers remain safe when dealing with critically ill patients.
Based on various scenarios, McLaughlin said the team practises techniques over and over again “so that when we’re in a real scenario we don’t contaminate ourselves.
“It is very clear from other areas that how meticulous we are in protecting ourselves is truly critical in how our whole medical system is going to work,” he said.
“In a small town where we have a very finite number of health-care workers, if one of us gets sick we’re out for two weeks.”
For example, if an emergency physician or nurse gets sicks, it could add extra shifts for other staff.
“That puts the burden on the rest of the crew for two weeks,” said McLaughlin.
“We’re focusing a lot on the safety of the patient obviously, but also a really big emphasis on the safety of our health-care workers.”
Presently, anyone entering Canmore hospital must be pre-screened, including health-care workers. The screening, which includes a person's temperature being taken and answering questions, is based on the latest requirements from Alberta Health Services.
“One of the unsung heroes of this are the screeners we have at the front desk,” said McLaughlin.
The hospital is counting on people to be honest about any symptoms they have. There is a specific area in the hospital dedicated to assessing people who show up with influenza-like symptoms.
🦠AD-VIRUS-ORY🦠— Canmore Fire Rescue (@CanmoreFireRes) April 6, 2020
TIME TO COVER FACES!
"A non-medical mask can reduce the chance of your respiratory droplets coming into contact with others, or landing on surfaces....we need to do everything that we can & it seems a sensible thing to do." ~ Dr Tam, 🇨🇦Chief Public Health Officer pic.twitter.com/8fISy75dT0
“It’s not that we’re going to refuse care to anybody that has it – far from that – but what we want to do is capture the people who have the symptoms that are characteristic to this disease process,” said McLaughlin.
“It helps us prepare, helps us protect ourselves so that we’re wearing the proper equipment and then we will move people to different areas of the hospital for assessment and treatment, where they will get the same great, high level of care that they always get.”
The emergency room team can’t stress enough how important it is to follow AHS regulations, such as two-metre distancing from each other, washing hands and avoiding gatherings.
“I know being self-isolated for this length of time is very difficult for the community, and we want to make sure that everyone is still following those plans,” said McLaughlin.
“We want to protect the most vulnerable in our community, our people in long-term care, the elderly and those more vulnerable to illness.”
Currently, there are no non-urgent lab tests or X-rays, and all elective surgeries have been postponed.
But staff also want to emphasize that people with serious medical problems or concerns should still head to the hospital.
“I don’t want people to be fearful of coming to the hospital,” said McLaughlin.
“There are still going to be heart attacks and strokes, but we are fully staffed to take care of those patients as well as preparing in the background for the influx of COVID patients.”
In McLaughlin’s parting words to the community, he wants to emphasize they are in good hands with all staff working very hard during these tough times.
“I can’t say enough about the team we have at the hospital. Across the board, their willingness to do their job is overwhelming,” he said.
“Nurses and doctors get talked about a lot, but there’s a lot of front line workers doing a heck of job – everything from maintenance, cleaners, screeners, administration, EMS, fire.”
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